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Old 07-11-2005, 01:09 PM   #1
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managing bipolar during pregnancy? (long)

I had an appointment with my p-doc yesterday, and one of the things he asked was whether and when I was planning to have children. The answer to "whether" was yes and as to "when", in the next couple of years.

Then he got into a discussion with me about pregnancy and bipolar. I'm bipolar II, and I tend towards depression. He said he would be really concerned about me having post-partum depression, that my previous depressions made it much more likely. He also said that he would want me to stay on my meds during pregnancy. I'm taking 300 mg of Lamictal daily, and it seems to have gotten me stabilized pretty well.

I know that Lamictal is an unknown risk for pregnancy--they've even got a registry for pregnant moms who use it, to track the rate of birth defects and such. My p-doc said that the rate of defects paralleled that of the general population. He said that plenty of women do take it during pregnancy and are fine, and that its pregnancy Class C classification wasn't a great indication of its safety. He said that the only drug that is class B (I'm only talking about psychiatric drugs) is Prozac, and that it was only labeled that because it was classified in the late 70's, when the FDA rules were much more lax.

He said that the only way to get a higher certification for a psychiatric drug was to do a double-blind study, and that it isn't really ethical to do that with pregnant women.

He also said that there can be major danger to your baby during a pregnancy if you are NOT medicated. He said that without meds, if your depression and anxiety levels go through the roof, you are much more likely to have pre-term labor.

And also, that if unmedicated, I'm much more likely to have post-partum depression. I asked if I couldn't just stay off meds for the pregnancy and begin immediately after the birth (or even in the third trimester), and he indicated that it might not be enough to prevent the post-partum or to allow the pregnancy to even get to the third trimester, and that if it is really bad, it's the type of depression from which some women never recover. (Incidently, he told me that post-partum depression is considered the most high priority psychiatric emergency, because of the potential severity of it and danger to both mother and baby).

So now I'm totally freaked out about these options. Not that I'm making this decision tomorrow or anything, but neither option sounds remotely appealing. Stay on the meds and risk problems with the baby, or go off the meds and risk problems to the baby (pre-term labor) and problems to me (post-partum depression).

Help! Can anyone shine some light on this?
Catie

 
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Old 07-11-2005, 02:16 PM   #2
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Re: managing bipolar during pregnancy? (long)

I'm one of the small percentage of women who chose to not have a baby.
For two very personal reasons:
1) Because I didn't want to go off my meds and end up going manic or depressed during a pregnancy - and the med I'm on has been proven to not work so well when I try you try to go back on it.
2) I just couldn't justify the risk to a fetus. No amount of wanting a baby would make up for the guilt if they had a birth defect - or inherited this from me.

Keep in mind, there are dozens of women who will tell you that their babies were born fine. I just personally must not have wanted a baby enough to take all the risks involved.

Now, years later I'm 51 - and while I honestly didn't miss having children, I must admit that not being a Grandma is a bit sad...

 
Old 07-12-2005, 06:43 AM   #3
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Re: managing bipolar during pregnancy? (long)

Wow, Ruth. Thank you for your reply. I'm so sorry that you've had to face that decision--I can only imagine how difficult it must have been.

What meds are you on? Right now I'm only on Lamictal.

--Catie

 
Old 07-12-2005, 08:18 AM   #4
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Re: managing bipolar during pregnancy? (long)

Catie - I had a few docs say the same things about your doc re: the medication issue - an OB/GYN and three p-docs. He/she is right about the risks to you in either situation. This is something that weighs heavily on me since I want to have another child.

I'm on Lamictal, too, and I'm not keen on getting off the drug. One doc said that lamictal carried significant risk for birth defects, and another said the risks aren't all that high.

Depression during pregnancy and postpartum came with the birth of my son. I went off my AD thinking that would be best for baby, but it wound up being a mistake for me and I had to start up with it again in my 2nd trimester. I felt worse than I'd ever felt before and only seemed to get worse until I found the right med combo with L and a couple of ADs. Really don't want to go through that again, so I know I'd have to have at least Lamictal next time around.

I'm thinking of adopting, but I miss the closeness of breastfeeding. My son and I bonded a lot during his first 9 months, and I can't imagine missing out on that with the next child. Hence, I'm still on the fence.

 
Old 07-12-2005, 09:49 AM   #5
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Re: managing bipolar during pregnancy? (long)

I'm on lithium.
20 yrs ago the the risk was that that a percentage of babies would be born with a heart defect and die. And the fact that I would most certainly either cycle into a psychotic mania or major depression if I went of the meds for the babies sake.
Now they aren't sure about that risk to the baby as much, but the risk that lithium would not work for me again if I stop taking it during pregnancy and try to get back on it - has increased.
<heavy sigh>
Thank heavens for lots of nieces and nephews and great-nieces and great-nephews!

Last edited by Ruth6:11; 07-12-2005 at 09:50 AM.

 
Old 07-12-2005, 10:07 AM   #6
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Re: managing bipolar during pregnancy? (long)

Hi Catie,

I understand completely where you're coming from, I have been dealing with the same issues. I had two children before I was diagnosed and medicated, and my husband and I want another one, and have been coping with infertility for years. I'm now seeing a Reproductive Endocrinologist, and have been on mood stabilizers, and ADs for some time, and doing really well with my bipolar. Anyway, I started treatments for my inftertility knowing I would have to stop taking my mood stabilizer, but I was told I could continue my ADs.

I did get pregnant sooner than I had expected, and the mood stabilizer was still in my system ~ and I miscarried. There is no way of knowing for sure what caused it, but all of my doctors wanted me to stay off of my mood stabilizer, thinking it was likely the cause....so, now here I am, struggling to stay sane, and not become manic, wondering every day what the right thing to do is.

It's really hard to say, it is a big risk to take either way. In my case, I have reason to need to concieve right away or not be able to ~ever. Which is a good reason to stop taking my meds.

I'm also going through a lot of stress with a custody battle over my oldest child, which is a good reason to continue taking them. What to do? I have gone back and forth several times, and I still don't know the right answer.

I wish I could help you more. I think you have to listen to your heart, and do what is best for you. If you have a good support system in place, you may be able to handle a short time off of your meds without serious consequenses..

I wish you the best of luck with whatever you choose!

~~heather~~

Last edited by polarized13; 07-12-2005 at 10:09 AM. Reason: mis-spelling

 
Old 07-12-2005, 01:11 PM   #7
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Re: managing bipolar during pregnancy? (long)

Heather, thank you so much for your reply. My heart goes out to you for all you've had to go through.

What mood stabilizer were you on when you had the miscarriage?

And what antidepressants did your docs say are ok for you to take right now while you're trying to conceive?

--Catie

 
Old 07-12-2005, 01:17 PM   #8
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Re: managing bipolar during pregnancy? (long)

Quote:
Originally Posted by Zbaby
Catie - I had a few docs say the same things about your doc re: the medication issue - an OB/GYN and three p-docs. He/she is right about the risks to you in either situation. This is something that weighs heavily on me since I want to have another child.

I'm on Lamictal, too, and I'm not keen on getting off the drug. One doc said that lamictal carried significant risk for birth defects, and another said the risks aren't all that high.

Depression during pregnancy and postpartum came with the birth of my son. I went off my AD thinking that would be best for baby, but it wound up being a mistake for me and I had to start up with it again in my 2nd trimester. I felt worse than I'd ever felt before and only seemed to get worse until I found the right med combo with L and a couple of ADs. Really don't want to go through that again, so I know I'd have to have at least Lamictal next time around.

I'm thinking of adopting, but I miss the closeness of breastfeeding. My son and I bonded a lot during his first 9 months, and I can't imagine missing out on that with the next child. Hence, I'm still on the fence.

Zbaby, thank you for your reply...

I'm curious, having never been there--how bad were your pregnancy depression and post-partum depression compared to a "normal" depressive episode? And when you were going through all that, how big a concern was pre-term labor?

And did you ever talk to your doc about being off meds just for conception and the first trimester, while everything is being formed in the baby?

Also, about breastfeeding--are you saying that if you're on meds, you definitely cannot breastfeed? That's my understanding, but I have a hard time comprehending how it can be ok for a baby to be exposed to the meds while in utero, but not ok for it to be exposed to them via breastmilk. Does that make sense?

What kind of doc was the one who told you that Lamictal could cause serious birth defects? It just seems nuts that there's no consensus in the medical community about this.

Sorry that this got to be so long--I appreciate your sharing your story.
--Catie

 
Old 07-12-2005, 02:34 PM   #9
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Re: managing bipolar during pregnancy? (long)

Catie - the depressions pre- and post-birth was the worst I've experienced as an adult that I can recall. Circumstances didn't help with a recent move to a new town, unemployment, isolation from friends and general confusion. I was off Celexa prior to pregnancy and during the first trimester - this is the time when defects are most likely to occur since major organs are being formed.

Celexa was a calculated risk for me during pregnancy, and I chose to breastfeed despite the transference of minute amounts of the drug through breast milk. I gave him my milk for 7 months, and he's always been pretty healthy aside from the usual illnesses that occur during the first few months of daycare (what a germfest!). Emotionally he's a very happy, outgoing boy who's affectionate and always smiling. Tantrums are age-appropriate, and they don't last very long.

Pre-term labor was not a concern at all. Aside from my depression, I remained physically health without a glitch in my pregnancy.

One p-doc warned against lamictal and another p-doc said it held relatively low risk. If you choose to stay on medication, you might want to talk to the OB-GYN about an amnio. This would give you an idea if there's anything wrong with the babe in utero.

 
Old 07-12-2005, 02:35 PM   #10
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Re: managing bipolar during pregnancy? (long)

You were saying that there should be a consensus of some sort in the medical community - but to be honest you answered that yourself earlier in your first post...
Quote:
He said that the only way to get a higher certification for a psychiatric drug was to do a double-blind study, and that it isn't really ethical to do that with pregnant women.
And that's the catch-22 right there.
In order to do a study with large enough numbers to mean anything, one would be potentially giving birth defects to dozens of babies.
So totally beyond ethical that they are left with information from women who have become pregnant while on these drugs either by choice or not thinking they would get pregnant.

It's a real dilemma, and its one that I wish had been talked about more years back...

 
Old 09-17-2006, 09:16 PM   #11
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Smile Re: managing bipolar during pregnancy? (long)

Hello,

I am currently pregnant -5 months completed and have bipolar. I was on Carbamazapine & effexor during conception, but my Psych. took me off all my meds and left me on a low dose of effexor and lorazapam when needed. I have had 2 ulrtasounds since and the doctor says everything is great. During the first trimester my mood was great. Now in my second, my depression and anxiety has been playing up-so now I am on clomophrine 20 m.g- for OCD and it is suppose to be safe. However, my Psych. does want to take me off the effexor completly and increase my lorazapam to 2 times a day, plus when needed. My OB is concerned because of increase depression and post-partum. I know I am going to start all my meds again after the baby is born, but in the meantime the doctors are observing my behaviour with the support of my family members. I have told my family if I become very depressed where I become unsafe to myself or the unborn baby to hospilize me. I understand the fear of being medicated during the first trimester and even thru the pregnancy as I don't want to harm my child, but I do keep an open communication to my husband, Psych. and family memebers when I feel my mood is begining to change so they can be more obsevant and re-act if need be.

Ycjc

 
Old 09-27-2006, 02:04 PM   #12
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Re: managing bipolar during pregnancy? (long)

Hi All,

well I was diagnosed after the birth of my daughter; my family all knew I was ill but i just wouldn't accept it. Sooooo, I had one of the worst mania's i have ever had after the birth of my daughter, with psychosis, paranoia; pre birth i weighed 9 stone (126 lbs) post partum within 2 weeks I was 6 1/2 stone. Not sleeping, eating, retiling the kitchen floor in the middle of the night......baby was fine though! And looked after.

I have decided not to have any more children due to the same reasons as you mention; plus i already have Charlotte and I couldn't risk being ill like that again under calculation.

It's a really tough decision. I really don't envy you. x

 
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